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The purpose of this viewpoint is to discuss and analyze three major governance tools that have been implemented in the United States to target tobacco smoking as a major public health concern.

The author highlights the negative consequences of smoking as a global and U.S public health concern and discusses three categories of governance tools implemented in the U.S. Additionally, emerging challenges in the U.S. and different sides of story in developing countries are underscored.

Although some success has been reached in controlling smoking-related mortalities and morbidities in the U.S. and most of the countries, long-term and sustainable improvement require active surveillance and constant implementation of evidence-based policies and programs.

This viewpoint discusses the governance tools that can be implemented to decrease smoking-related preventable mortalities and morbidities. Similar tools with some tuning can be used to target smoking in other nations. Additionally, these tools can be modified to target other public health-related wicked problems such as obesity, alcohol consumption, and traffic accidents.

This viewpoint highlights the magnitude of smoking as a major public health concern and underscores the necessity of using governance tools in targeting this issue. Additionally, it provides application examples from the United States implementable in other countries with some contextual justifications and tuning.

Since the development of the COVID-19 vaccinations, questions surrounding race have been prominent in the literature on vaccine uptake. Early in the vaccine rollout, public health officials were concerned with the relatively lower rates of uptake among certain racial/ethnic minority groups. We suggest that this may also be patterned by racial/ethnic residential segregation, which previous work has demonstrated to be an important factor for both health and access to health care.

In this study, we examine county-level vaccination rates, racial/ethnic composition, and residential segregation across the U.S. We compile data from several sources, including the American Community Survey (ACS) and Centers for Disease Control (CDC) measured at the county level.

We find that just looking at the associations between racial/ethnic composition and vaccination rates, both percent Black and percent White are significant and negative, meaning that higher percentages of these groups in a county are associated with lower vaccination rates, whereas the opposite is the case for percent Latino. When we factor in segregation, as measured by the index of dissimilarity, the patterns change somewhat. Dissimilarity itself was not significant in the models across all groups, but when interacted with race/ethnic composition, it moderates the association. For both percent Black and percent White, the interaction with the Black-White dissimilarity index is significant and negative, meaning that it deepens the negative association between composition and the vaccination rate.

The analysis is only limited to county-level measures of racial/ethnic composition and vaccination rates, so we are unable to see at the individual-level who is getting vaccinated.

We find that segregation moderates the association between racial/ethnic composition and vaccination rates, suggesting that local race relations in a county helps contextualize the compositional effects of race/ethnicity.